Neurological Complications in HIV Infection/AIDS

1. Neurological Complications in HIV Infection/AIDS Dr.K.Bujji Babu, MD., HIV Physician Consultant Bujji Babu HIV Clinic Kanuru Vijayawada

2. Introduction • Deadly DUO in HIV infection --Opportunistic infections -- Neoplasms • Team effort -- HIV physician -- Neurologist -- Radiologist, Microbiologist & Pathologist

3. AIMS • Discuss patient profiles in AIDS • Diagnostic dilemmas • Treatment: Options, Complications, Limitations

4. Epidemiology • Duration: 2 years • Total no HIV/AIDS cases: 490 • No of patients with neurological complications:50 • Male:Female: 31:19 • Age group : 25-55 years

5. Patient Profile • Clinical examinations • Laboratory Investigations • Confirmation of serological status by ELISA/W.B • Hb%, TC, DC, ESR, VDRL, Hep A,B & C, S.Bilirubin, S.Creatinine, S.Amylase, Serum IgG for Toxo, Montoux, CXR, USG abdomen, Urine examination • CD4 for Immunological status

6. CNS Examination • Clinical Examination • Examination of fundus • Laboratory study CSF Study Chemical Analysis, AFB, Gramstain, Culture sensitivity, KOH, VDRL, Indian Ink Preparation for Crypto, Cryptococcal antigen, PCR. • MRI study

7. Tubercular meningitis • No. of Patients: 8 (M:F-5:3) • Clinical Features: Fever, Headache & Vomiting • CSF Analysis AFB Positive for 3 (1F, 2 M) AFB Negative for 5 (1F, 4M) • CD4 count • Mortality: One patient died in advanced stage, even after shunting for TBM with hydrocephalous

8. TB Spine • No. of Patients : 2 (M:F-1:1) • Clinical Features: Fever, Backache, Loss of weight • Diagnosis : MRI spine • Treatment : ATT followed by ART • Results:Therapeutic response very good both TBM & TB spine when the CD4 > 150

9. Cryptococcal Meningitis • No. of patients: 8 [M:F- 5:3] • Clinical features: Throbbing Headache, Fever, Occasional Convulsions. • CD4 < 150 • CSF: High Pressure, Clear Fluid • Indian ink for Cryptococcus +ve (5 cases) • Cryptococcal antigen +ve (3 cases) • Treatment: Fluconazole 200mg IV BD, Amphotericin B 0.7mg/kg & followed by ART • Mortality: 2 [M:F-1:1]

10. Toxoplasmosis • No. of Patients: 6 ( M:F- 5:1) • Clinical Features: Fever & Seizures • Diagnosis: Serum IgG Toxo, MRI • CD4 < 200 • Treatment: Anti TOXO Alternative: Clindamycin & Dapsone Followed by ART • Mortality: 1

11. PML • No. of Patients: 6 (M:F- 4:2) • Clinical features: Loss of memory, irrelevant speech, insomnia • Diagnosis : MRI • CD4 <150 • Treatment: Symptomatic & ART • Mortality: 1

12. Cerebral Atrophy • No. of Patients: 3 (M:F-2:1) • Clinical Features: Loss of memory,irrelevant speech,insomnia insomnia • Diagnosis – MRI • CD4 < 150 • Treatment: Symptomatic & ART

13. Pneumococcal Meningitis • No. of patients – 2 (M) • Clinical Features: Fever, Headache and vomiting • Diagnosis: CSF analysis, Gram stain / CultureRx • Treatment : standard+ ART • Results: 1 patient died, CD4 = 27, one patient survive CD4 = 150

14. HIV Myelopathy with Myopathy • 1 (F) patient • Clinical Features: Tingling sensation & weakness in lower limbs • CD4:110 • Treatment : ART

15. Facial Palsy due to Herpes-Zoster • No. of cases: 6 (M:F-4:2) • Diagnosis – Clinical • CD4 < 200 • Treatment: Acyclovir , Famcyclovir , Valcyclovir Physiotherapy

16. Peripheral Neuropathy • No. of Patients: 5 (M:F- 3: 2) • Cause : Mainly drug induced • Clinical Features: Numbness, tingling sensations & weakness in lower limbs • CD4 : 50 – 150 • Diagnosis : Clinical and NCS • Treatment : Vitamin supplements

17. Spinal Masses Other than KOCH’s • No. of Patients: 3 (M:F- 2:1) • Clinical Features: Fever, Paraplegia,Urinary retention, Bowel incontinence • CD4; < 100 • Diagnosis: MRI & Biopsy • Results : 1(M) Secondary from renal cell Ca. - died 1(M) NHL operated - doing well 1(F) Spinal inflammatory/Neoplastic lesions nature not known (died because neutropenia)

18. Conclusion TBM , Crypto, Toxo CD4 < 200 Cerebral atrophy & PML Neoplasms common CD4 <100 Neuro AIDS -- More common -- high morbidity -- Very high mortality -- ART

36. Thank You